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M4: OSCE > Temporomandibular Joint And Occlusion Station > Flashcards

Temporomandibular Joint And Occlusion Station Flashcards

1
Q

What is the ICP?

A

Intercuspal position: maximum interdigitation (dependent on dentition to be reproducible)

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2
Q

Does your patient have a reproducible ICP?

A

Get patient to bite together a few times and gauge.

PDL mechanoreceptors aid sensing movement back into the same position, therefore dentate patients should have a reproducible ICP but the more teeth lost i.e. edentulous patients, the more likely the ICP is not reproducible.

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3
Q

How to identify suitable index teeth

A

When the patient is biting together which teeth clearly meet together in a reproducible way i.e upper 5, lower 4.

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4
Q

Fox’s guide plane

A

Device held to the maxillary arch to gauge the occlusal plane - important when making dentures i.e. can make adjustments where necessary.

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5
Q

What reference planes are used when using a Fox’s guide plane?

A

Interpupillary line
Ala-tragal line

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6
Q

How would you examine the contact of teeth for ICP and excursions?

A

Using articulating paper: patient bites down into ICP then slides the teeth to left and right.

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7
Q

What is RCP?

A

Retruded contact position

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8
Q

What is retruded contact position?

A

Condyle retruded in the glenoid fossa, teeth in contact but ~1-2mm posterior to ICP (can sometimes be the same as ICP)

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9
Q

How would you get your patient into RCP?

A

Curl tongue to the back of the mouth and bite together.

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10
Q

OVD

A

Occlusal vertical distance (height of the lower 1/3 of the face when in the ICP)

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11
Q

RVD

A

Resting vertical difference (height of lower 1/3 of face when in the resting postion)

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12
Q

FWS

A

Freeway space

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13
Q

How is the Freeway space determined?

A
  1. Looking at patient at rest
  2. Looking at patient speaking
  3. Two dots and measure
  4. Mirror handle and hand
  5. Willis gauge
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14
Q

Willis gauge

A

Used to gauge the freeway space

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15
Q

Set up of Willis gauge

A

Note: can check it’s set up correctly by checking it makes a “T” shape

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16
Q

How is the free way space calculated?

A

RVD - OVD = FWS

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17
Q

How to get a patient into the rest position?

A

Lick lips and swallow, gently close lips together.

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18
Q

What would a patient with a large freeway space look like?

A

Appear more ‘squished’ or ‘older’

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19
Q

Appearance of a patient with a very small FWS?

A

Much ‘longer’ lower 1/3 of face “horsey”.

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20
Q

What materials are available for recording occlusion?

A
  1. Dental impression gun (mixes the material inside)
  2. Pink wax (heat with warm water)
  3. Grey wax (harder)
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21
Q

Condylar movement: working side (side moving towards)

A
  1. Rotates around vertical axis
  2. Lateral bodily movement (Bennett movement)
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22
Q

Condylar movement: Non-working side (side jaw’s moving away from)

A
  1. Moves downwards/forwards over eminence
  2. Moves medially

This movement is the Bennett Angle

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23
Q

Does balances occlusion occur in natural teeth?

A

No (cannot exist in normal dentate occlusion)

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24
Q

Does balances occlusion occur in dentures?

A

It’s opted for to provide stability for full dentures. Basically means that as much teeth are in contact as possible —> can be difficult to achieve!

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25
Q

Why might freeway space be important when making dentures?

A

IT MUST BE ACCOUNTED FOR:
When the denture base has been raised inappropriately to the rest position; that is, with teeth contacting at this position, the result is that the mandibular musculature, especially the masseter, becomes severely stressed.

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26
Q

Occlusion can be guided by either…

A
  1. Canine guidance
  2. Group function
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27
Q

Why is it important to know how the occlusion is guided?

A

For selecting the correct articulator when making dentures (also can be important when doing restorative work).

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28
Q

What is the average FWS?

A

2-5mm

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29
Q

How would you estimate FWS in Edentulous patients?

A

RVD + 3 —> then adjust denture accordingly!

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30
Q

Describe the anatomy during: jaw opening

A

hinge movement with the condyle turning round an axis

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31
Q

Describe the anatomy during: wide jaw opening

A

hinge and slide movement of the condyle

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32
Q

Describe the anatomy during: wide jaw opening

A

hinge and slide movement of the condyle

33
Q

Describe the anatomy during: protrusion

A

Sliding forwards of the condyle

34
Q

TMJ: basic description

A

a synovial joint between temporal bone and mandible

35
Q

Features of a synovial joint

A

Synovial fluid inside a synovial membrane attached by a joint capsule to two bones.

Hyaline articular cartilage covering each bone.

36
Q

Joint capsule of the TMJ

A

Attached to the glenoid fossa.
2 layers: outer fibrous layer, inner synovial membrane.

37
Q

What does the synovial membrane do?

A

Secretes synovial fluid to fill the space (proteoglycans, lubricant, nutritive).

38
Q

Lateral ligament of TMJ

A

Part of the capsule.
Attaches: lateral surface of articular eminence - posterior surface of condyle

39
Q

What role does the lateral ligament play?

A

Restricts posterior, lateral, inferior, contra lateral medial, and pure hinge movement.

40
Q

What are the three accessory ligaments of the TMJ?

A
  1. Stylomandibular
  2. Sphenomandibular
  3. Pterygomandibular raphe
41
Q

What are the 5 zones of the articular disc?

A
  1. Anterior extension
  2. Posterior extension
  3. Anterior band
  4. Intermediate zone
  5. Posterior band
42
Q

In the posterior extension of the articular disc there is an upper and lower layer, what is different about these two layers?

A

Upper —> vascular and elastic

Lower —> fibrous

43
Q

The anterior extension of the articular disc is continuous with the ____________.

A

superior head of the lateral pterygoid muscle.

44
Q

Nerve supply to the TMJ

A

V3

  • auriculotemporal
  • masseteric
  • deep temporal
45
Q

TMJ blood supply

A
  • superficial temporal artery
  • maxillary
46
Q

What should happen to the articular disc as the condyle moves?

A

It should move with it..

47
Q

What is anterior disc displacement?

A

When the articular disc has moved anterior to the condyle.

WIT REDUCTION: means that as the condyle slides forwards during mouth opening there is a click and the disc snaps into place.

48
Q

Superficial and deep Masseter: insertion and origin

A

Origin: zygomatic arch (superficial) and inner aspect of zygomatic arch (deep)

Insertion: angle/ramus of mandible (same for both)

49
Q

Function of the masseter

A

Jaw elevation (closing)
Minor protrusive (superficial masseter only)

50
Q

Innervation of masseter

A

Vc Motor root - masseteric nerve

51
Q

Temporalis: origin and insertion

A

Origin: inferior temporal line and fascia

Insertion: coronoid process

52
Q

Function of temporalis muscle

A

Jaw elevation and retrusion (posterior fibres)

53
Q

Temporalis innervation

A

Vc motor root - deep temporal nerve

54
Q

Lateral pterygoid (upper head) insertion and origin

A

Insertion: capsule and articular disc of TMJ

Origin: infratemporal surface of greater wing of sphenoid

55
Q

Lateral pterygoid (lower head) insertion and origin

A

Origin: lateral aspect of lateral pterygoid plate

Insertion: pterygoid fovea below head of condyle

56
Q

Is the lateral pterygoid a true jaw opener?

A
  • Not involved during initial opening
  • However, during wide opening the inferior lateral pterygoid (green) allows the movement of the condyle downwards and forwards (“slide”)
57
Q

What are the three functions of the inferior head of the lateral pterygoid muscle

A
  • protrusion (sticking out jaw forwards
  • assists opening
  • lateral excursions (unilateral pull of condyle forwards)
58
Q

Lateral pterygoid (superior head) function

A
  • Retrusion and closing
59
Q

Medial pterygoid: insertion and origin

A

Origin: medial aspect of lateral pterygoid plate (deep head) and Maxillary tuberosity (superficial head)

Insertion: medial aspect of ramus/angle of mandible

60
Q

Function of medial pterygoid muscle

A
  • Jaw elevation
  • Assists protrusion and lateral excursions (unilateral)
61
Q

Innervation of medial pterygoid

A

Vc motor root - nerves to medial pterygoid

62
Q

Genohyoid: origin and insertion

A

Origin: inferior mental spine & inferior genial tubercle

Insertion: hyoid bone

63
Q

Geniohyoid function

A

Hyoid fixed: opening/retrusion of mandible

Hyoid not fixed: raise/forward hyoid bone

64
Q

What nerve innervates the geniohyoid?

A

C1 (with hypoglossal)

65
Q

Mylohyoid muscle attachments

A

originates from mylohyoid line on the mandible.

Inserts into itself at the median raphe

Finally inserts into hyoid bone

66
Q

Mylohyoid function

A

Hyoid fixed: jaw opening
Hyoid not fixed: raise hyoid and FOM

67
Q

innervation of mylohyoid

A

Vc motor root - nerve to mylohyoid (branch of IAN)

68
Q

Anterior belly of diagnostic origin and insertion

A

Origin: digastric fossa
insertion: intermediate tendon (—> posterior belly)

69
Q

Anterior belly of digastric action

A

Hyoid fixed: jaw opening
Hyoid not fixed: raise hyoid

70
Q

Innervation of ABD

A

Vc motor root - via nerve to mylohyoid (branch of IAN)

71
Q

What are the hyoid stabilisers (5)?

A
  • Sternohyoid
  • Omohyoid
  • Thyrohyoid
  • PBD
  • Stylohyoid
72
Q

What is the function of the hyoid stabilisers?

A

Simultaneous contraction of these muscles will stabilise the hyoid bone, allowing the other muscles to act as depressor muscles.

73
Q

Plane line articulator

A

Hinge axis may be more anatomical but arbitrary. The simpliest type of articulator consisting of a simple hinge joint. No lateral or sliding movements are possible with a plane line articulator.

74
Q

Average value articulator

A

Provide lateral excursive and protrusive movements and have condylar inclinations set to an average value of 30°.

Simple fixed prosthetics for teeth not involved in guidance/removable prosthetics.

75
Q

Denatus articulator

A

Non-arcon (condyle part of maxillary component)

76
Q

Denar Mark II articulator

A

Arcon (condyle part of mandibular component)

77
Q

Facebow

A
  1. Relates maxillary cast to inter-condylar axis but uses ear as a reference.
  2. Orientation of cast in vertical dimension governed by a marker relating to the lateral incisor
78
Q

What informs the articulators condylar guidance angles?

A

At least two interocclusal records
1. Retruded contact position
2. Plus relevant excursions

79
Q

What can Denar Mark II Arcon articulators be used for?

A

it can be used for more advanced restorative work such as bridges, implants , orthodontic repositioning

M4: OSCE (9 decks)

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